Foreword

As of early 2026, the global economy is navigating a “new world disorder” defined by a polycrisis of interconnected geopolitical, economic, and environmental shocks that continue to strain societies worldwide. The lingering spillover effects of the COVID-19 pandemic, which escalated globally in 2020, remain deeply embedded, driving uneven economic recovery, heightened inequality, persistent inflation, energy disruptions, education losses, and growing social mistrust and political polarization. In 2020 alone, global debt surged by $19.5 trillion as governments financed pandemic relief and corporations issued record levels of bonds, leaving a lasting fiscal burden. These overlapping pressures have intensified the costof- living crisis, reduced purchasing power and worsening food insecurity for millions. The uneven recovery has fueled widespread public anger and political instability, particularly in countries already weakened by high debt and rising living costs, leading to protests and power struggles. At the same time, the global economic toll of armed conflict reached approximately $19 trillion to $20 trillion annually by 2024–2025, accounting for over 11% of global economic output and translating to roughly $2,380 to $2,446 per person. Conflicts—whether domestic or international—continue to devastate infrastructure, disrupt trade, trigger humanitarian crises, and erode human capital. Economically, such instability reduces GDP growth by an average of 2 percentage points per year, with severe conflicts causing contractions of up to 4 percentage points in the first year alone. Since 2020, major geopolitical tensions, including the Ukraine war, escalating Middle East conflicts, and the US–China rivalry, have further destabilized global systems through supply chain disruptions, elevated energy prices, and sustained inflationary pressures. Meanwhile, climate-related disasters have nearly doubled over the past two decades, with 7,348 major events recorded between 2000 and 2019, underscoring the accelerating frequency of environmental shocks. Current projections estimate that climate change could inflict annual economic damages of around $38 trillion by 2050, compounding existing vulnerabilities. Together, these crises have stalled or reversed progress on the UN Sustainable Development Goals, making poverty alleviation increasingly difficult. Additionally, warnings from the IMF and WTO highlight the risk of “slowbalization,” where rising trade tensions and geopolitical fragmentation could reduce global GDP by up to 7% over the long term. Ultimately, these intertwined challenges reveal how the ongoing economic strain, conflict dynamics, and climate crisis are deeply interconnected with the uneven recovery from the pandemic, reinforcing a prolonged and complex global instability.

The COVID-19 pandemic, ongoing armed conflicts, and escalating climate extremes are deeply interwoven forces driving today’s socioeconomic challenges by jointly straining health systems, disrupting economies, and destabilizing societies. Healthcare infrastructure has been overwhelmed and weakened, limiting access to essential services while increasing disease burden and mortality risks. Economies continue to face recessionary pressures, business disruptions, job losses, and fragile supply chains that amplify shortages and raise living costs. Inflation and tighter financial conditions have reduced household purchasing power, deepening inequality and financial insecurity. At the same time, food insecurity has expanded as climate-related shocks and conflict-driven disruptions damage agricultural production, supply chains, and distribution networks. Environmental degradation and extreme weather further intensify water scarcity, crop failures, and long-term resource stress, which in turn heighten competition over basic necessities in vulnerable regions. These pressures contribute to localized conflicts, displacement, and social instability, while armed conflicts themselves further destroy infrastructure, disrupt trade, and weaken governance systems. Healthcare delivery becomes even more fragmented in conflict zones, limiting vaccination, disease control, and emergency response capacities. The combined effects of environmental stress and political violence also facilitate the spread of infectious and chronic diseases, compounding public health burdens. Energy systems are destabilized by geopolitical tensions and delayed transitions, increasing reliance on fossil fuels and adding further economic strain. Meanwhile, accumulating debt and prolonged fiscal pressures constrain recovery and development efforts across many countries. As living conditions deteriorate, public frustration grows, often manifesting in protests and broader political instability. Ultimately, these interconnected crises reinforce one another, creating a persistent cycle of vulnerability that undermines global recovery and resilience. The analysis on Intertwined relationship between the 3Cs discusses how COVID-19, armed conflicts, and climate extremes operate as a connected “3C” crisis that jointly amplifies global socioeconomic instability. COVID-19 disrupted economies, supply chains, energy transitions, and livelihoods, while armed conflicts and climate extremes further intensified resource scarcity, displacement, inflation, and public health deterioration. Together, these overlapping pressures expose systemic fragility and underscore the need for integrated, multidisciplinary, and internationally coordinated policy responses rather than isolated interventions.

As of 2025–2026, over half of the global population lacks access to comprehensive healthcare, while about one in four people still faces financial hardship in accessing services and roughly one in five is pushed into poverty due to medical costs. Although out-of-pocket health spending has declined between 2000 and 2022, it continues to affect about a quarter of the global population, showing stalled progress toward universal health coverage since 2015. Medicines represent 20–60% of health expenditures in developing countries, with up to 90% of people relying on out-of-pocket purchases, making them the second-largest household expense after food. More than one-fourth of the global population still lacks access to essential medicines, exceeding 50% in many low- and middle-income countries in Africa and Asia. Underfunded primary care systems, unequal health workforce distribution, and migration from low- to high-income countries weaken system capacity, while a projected shortage of up to 10 million health workers in LMICs by 2030—half in Africa—further deepens structural gaps. These challenges are compounded by insufficient training, widening inequalities, and the rising burden of over 40 emerging infectious diseases alongside shifting disease patterns and climate- and conflict-driven health pressures. The COVID-19 pandemic, emerging in the early 2020s, created a global health emergency with about 775 million cases and 18–33 million deaths by 2024, overwhelming health systems and disrupting essential services in more than 90% of countries, including sharp declines in immunization, maternal care, and chronic disease management due to workforce shortages and supply chain breakdowns. It exposed deep weaknesses in surveillance, financing, preparedness, and equity, particularly in under-resourced settings, while vaccine development and mass immunization reduced severity but were undermined by unequal access and misinformation. Meanwhile, armed conflicts have persistently undermined global health, causing an estimated 29 million excess deaths between 1990 and 2017, with civilians accounting for about 90% of conflictrelated fatalities and health systems collapsing in many regions where only half of facilities remain functional. These conflicts drive mass displacement, malnutrition, and outbreaks such as cholera, measles, and polio, including over one million cholera cases in Yemen, alongside rising antimicrobial resistance, maternal and child mortality, and severe mental health burdens. Climate change further compounds these crises, with global warming already exceeding 1.5°C and projected to reach about 2.7°C by 2100, driving extreme heat events linked to a 167% rise in mortality among adults over 65 since the 1990s. Climate-related hazards cause over 150,000 deaths annually and millions of DALYs, while sea level rise of over 24 cm, water insecurity affecting billions, and hunger impacting over 730 million people intensify health vulnerabilities. Additionally, climate change is expanding vector-borne disease risks for 260–320 million more people and worsening malnutrition, respiratory illness, and mental health disorders. Together, COVID-19, armed conflicts, and climate change interact to destabilize health systems, widen inequalities, and amplify both infectious and non-communicable diseases, revealing a global health system under sustained and compounding stress. The chapter on Global health system discusses how the COVID-19 pandemic, armed conflicts, and climate extremes have jointly strained global health systems by disrupting essential services, overwhelming infrastructure, causing workforce shortages and burnout, destroying facilities, displacing populations, and intensifying infectious and non-communicable diseases while deepening inequalities in access to care and medicines. Overall, it concludes that these interconnected crises disproportionately affect vulnerable groups and require resilient health infrastructure, integrated health–environment–security policies, and coordinated global action to ensure equitable and sustainable health system recovery.

The Green Revolution since the 1950s boosted food production by introducing high-yield seeds dependent on fossil fuel–based fertilizers, pesticides, irrigation, and mechanization. While it increased yields, it also tightly linked global food security to fossil fuel inputs, creating long-term social, ecological, and vulnerability costs. The onset of the COVID-19 pandemic then disrupted global food systems by breaking supply chains, restricting transport, and reducing labor mobility, triggering severe economic shocks affecting 2.7 billion workers and pushing 150 million people into extreme poverty by 2020. During this period, food insecurity rose from 11% to 38% in the United States and up to 80% in parts of India, alongside a shift toward cheaper, less nutritious diets. In the post-COVID period, armed conflicts have become a major driver of global hunger by destroying agricultural systems, displacing populations, and increasing fuel, transport, and fertilizer costs, with conflict accounting for about 70% of acute food insecurity. By 2024–2025, nearly half of the world’s 1.1 billion poor were living in conflict-affected areas. By August 2025, catastrophic IPC Phase 5 famine conditions were reported in six regions—Sudan, Gaza Strip, South Sudan, Yemen, Haiti, and Mali—affecting about 1.4 million people amid conflict, while at least 14 countries experienced worsening food crises driven by conflict, economic shocks, climate extremes, and displacement, with the most severe situations in Gaza, Sudan, Yemen, and South Sudan. By 2026, this contributed to over 318 million people facing acute food insecurity, including an additional 45 million linked to escalations in the Middle East, where starvation has increasingly been used as a “weapon of war.” Since 2019, climate extremes—intensified by planetary boundary stress—have acted as a “risk multiplier,” with 59 countries facing climate-driven food crises and 48 million people affected in 12 African countries in 2023 alone. In the Asia-Pacific region, shocks such as China’s 20% crop losses during 2022 heatwaves and Pakistan’s floods damaging 60% of crops further destabilized global supply chains. Together, these overlapping crises have exposed systemic fragility by reducing production, disrupting trade, raising prices, and limiting access to food, disproportionately affecting low-income populations, smallholder farmers, and importdependent countries, leaving over a quarter of the global population in moderate to severe food insecurity by 2025–2026. The chapter on Global Food Insecurity shows how COVID-19, armed conflicts (especially the Russia–Ukraine war), and climate extremes jointly disrupt food systems, breaking supply chains and inflating food and fertilizer prices, pushing over 700 million people into hunger and leaving billions unable to afford healthy diets, underscoring the need for coordinated global action on resilience, adaptation, and sustainable food systems.

The US–China rivalry, rooted in China’s rapid post-2001 WTO-driven rise and long-standing disputes over trade imbalances, state subsidies, market access, jobs, and intellectual property, has evolved since the 2018 trade war into a broader strategic competition over technology, semiconductors, AI, critical minerals, and global supply chain dominance, driven by economic nationalism and national security concerns; this has disrupted global supply chains through tariffs, export controls, and regulatory barriers, raising production costs, weakening industrial output, and slowing global GDP growth while increasing consumer prices in the U.S. and reducing export markets for sectors like American agriculture, and constraining China’s export-led growth and tech firms such as Huawei through semiconductor restrictions; it has also weakened multilateral institutions like the WTO and accelerated fragmentation into regional blocs such as the Regional Comprehensive Economic Partnership (RCEP) and the African Continental Free Trade Area (AfCFTA), while prompting firms to relocate production to countries like Vietnam and Mexico, which together gained over $10 billion in diverted trade and benefited from rising FDI inflows; however, the EU and Japan suffered export losses, and emerging economies such as India, Pakistan, and ASEAN members experienced short-term gains from trade diversion but face long-term risks of dependency, volatility, and geopolitical pressure; overall, the rivalry is now widely seen as a structural and enduring global economic shock distinct from past crises like 2008 or COVID-19, reshaping global capital flows, governance, and supply chains into a more fragmented and multipolar world economy characterized by strategic hedging and persistent instability. The chapter on U.S.–China rivalry captures this transformation masterfully, describing the rivalry as a force that replaces global integration with realignments, protectionism, and uneven impacts—pointing toward an uncertain future.

As of early 2026, global drug and medical supply chains are in a structural crisis, with nearly half of essential medicines dependent on single-country inputs and fragile supply networks, making them highly vulnerable to logistics shocks, airfreight limits, rerouting, and rising fuel costs. Historical events such as the 1942 Quinine Crisis (90% loss of global antimalarials) and Hurricane Maria (U.S. IV saline shortages) show how concentrated production amplifies systemic fragility. Evidence from a BMJ Global Health study using 2011–2022 data from 74 countries shows that drug shortages are not primarily driven by prices but by structural capacity—countries with greater economic strength and more manufacturers experience fewer and shorter shortages, highlighting the importance of diversified production over pricing strategies. Across studies, shortages consistently stem from upstream failures such as manufacturing disruptions, weak incentives, poor transparency, and limited coordination, while most policy responses remain reactive (e.g., substitutions and stockpiling), reinforcing the need for proactive, system-level prevention at early supply chain stages. In high-income countries, shortages arise from overlapping actors—manufacturing failures, demand spikes, logistics inefficiencies, and regulatory constraints—but responses still focus on downstream fixes, creating a persistent mismatch between causes and solutions. Geopolitical conflicts and trade tensions often produce delayed rather than immediate shortages by disrupting global production hubs and trade routes like the Strait of Hormuz, disproportionately affecting generic drugs reliant on concentrated manufacturing in India and China. The COVID-19 pandemic exposed these vulnerabilities at scale, with export restrictions, concentrated production, and demand surges causing global shortages of PPE, diagnostics, and medicines, alongside sharp price increases and governance failures. A study by researchers from Clemson University show that geopolitical strain and export bans reshape pharmaceutical production and pricing, sometimes increasing firm profitability but worsening global inequities, as high-income countries remain protected while low-income regions face persistent shortages without coordinated pricing and subsidy systems. The war in Ukraine further illustrates energy-driven shocks, where gas and fuel price spikes raised production costs for about 70% of European pharmaceutical firms, increasing downstream prices. US–China trade tensions have intensified shortages of medical accessories through tariffs, logistics disruption, and dependence on Chinese manufacturing, accelerating costly diversification efforts. The 2026 Hormuz strait blockade adds further strain by disrupting the Persian Gulf pharmaceutical transit hub, reducing shipping and air cargo capacity, and increasing risks of delays in cold-chain medicines, IV fluids, MRI helium, and overall cost inflation. Finally, climate change is compounding all these pressures by increasing extreme weather events that damage infrastructure, disrupt transport, degrade cold-chain systems, and shift disease burdens—simultaneously raising demand for medicines while weakening global supply resilience. The chapter on drug and medical supply discusses how global crises—including pandemics, wars, sanctions, economic shocks, and climate change—have exposed severe fragility in highly concentrated pharmaceutical supply chains, leading to widespread shortages of essential medicines and medical technologies. It highlights deep global inequities driven by dependence on a few manufacturing hubs (China and India), alongside COVID-19, conflict, and policy disruptions, underscoring the urgent need for diversified production and stronger international coordination.

Global supply chain disruptions stem from overlapping geopolitical forces—internal instability, interstate tensions, terrorism, economic conflicts, nationalism, and wars—that interrupt material flows, logistics, and regulatory systems across regions. Events such as COVID-19 trade restrictions, the US–China trade war, Brexit, Red Sea attacks, and the Russia–Ukraine war demonstrate how these shocks raise costs, delay production, and create cascading global ripple effects. During the pandemic, supply chain fragility intensified as just-in-time systems collapsed into bottleneck-prone networks facing labor shortages and rising operational costs, with global shortages surging by more than six times. Currency devaluation has acted in tandem with these disruptions, amplifying procurement costs and financial instability, particularly in import-dependent sectors like automotive and technology. Even a 5% exchange rate shift can significantly erode profit margins, delay product launches, and increase transport expenses, especially for SMEs lacking hedging capacity. Supply chain stress has translated directly into inflationary pressures, as reflected in the Supply Chain Pressure Index during crises such as the 2008 Global Financial Crisis, when oil prices exceeded $140 per barrel, and again during COVID-19, with inflation rising more persistently in the US than in the EU. In low- and middle-income countries, currency depreciation sharply raises the cost of essential imports—food, fuel, and medicine—triggering shortages and severe inflation. India illustrates this dynamic, where devaluation increases import costs in manufacturing, pharmaceuticals, and automotive sectors while boosting export competitiveness in textiles and IT, though short-term inflation and debt burdens, as seen in the 1991 crisis, often offset early gains. In conflict-affected economies, devaluation magnifies humanitarian crises; for instance, Yemen, which relies on imports for about 90% of its needs, faces acute shortages as weakened currency restricts access to hard currency for trade. Lebanon provides another stark case, where the pound has lost over 98% of its value since 2019, with the official rate shifting from 1,500 to 15,000 per US dollar in February 2023 while parallel market rates remain far weaker, fueling hyperinflation, poverty, and dollarization through 2024–2025. Similarly, amid international sanctions, Iran’s rial fell to around 1,500,000 per US dollar by January 2026—an 800% decline since 2020—driven by sanctions, economic mismanagement, and SWIFT restrictions, which have forced reliance on alternative financial channels and intensified scrutiny of global transactions. This collapse in currency value has drastically reduced purchasing power, increased inflation, and contributed to social unrest, while pushing essential goods like milk to more than 800,000 rials per liter. Together, these cases show how supply chain disruptions, currency volatility, and economic activity are tightly interconnected, reinforcing each other to produce prolonged instability, inflationary spirals, and unequal global economic impacts. The chapter on Global supply chain crisis analyses how overlapping shocks—from the pandemic to geopolitical conflicts and trade tensions—disrupted global trade, exposed structural weaknesses in supply systems, and destabilized economic activity. It emphasizes how currency volatility and policy responses interacted with these disruptions to deepen inflation, inequality, and vulnerability, highlighting the need for more resilient and diversified supply chains.

Therefore, the discussion reveals a deeply interconnected global polycrisis where pandemics, armed conflicts, economic instability, and climate change collectively disrupt health systems, food security, supply chains, and economic stability. These overlapping shocks amplify inequality, inflation, debt burdens, and social unrest while weakening governance, trade systems, and access to essential services worldwide. The analysis highlights how structural fragilities—such as concentrated production, import dependence, and fragmented global cooperation—intensify vulnerabilities across regions and sectors. By understanding these interlinked crises, readers gain a holistic perspective that can inform more resilient, coordinated, and forward-looking policy and research approaches.